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Actually quite the opposite! I'm a very strict constitutionalist, thus I believe the government's job is rather limited.

I was just saying that the standard talk radio assumption (that I used to agree with) that if you're poor, it's your fault. That's certainly not true at all. I worked my ass of in college (while working full time)to get my grades, but I can't even get an employer to give me a call back. But then again I'm still trying to take steps (like starting grad school next month) to make my life better, for the time being I'm still using my vocation rather then my education.

i doubt anybody would call you poor or "one of those people" if they knew about the work you put in.

but i'm not denying there is an element of luck in getting a great job right out of college. and the market's flooded with college grads with these easy student loans (government-backed student loans which private lenders wouldn't touch). maybe if those people taking out loans had to work and go to school at the same time as you, the market wouldn't be so bad.

but this is a multi-faceted problem from too much supply to not enough demand. it's my belief that government is to blame for a lot of it. there are so many unintended consequences when do-gooders think they can fix everything about society. but i don't propose to have the answers for what to do now, in your case in particular since i can't really relate. i didn't work hard in school or have a job through school, and i'm one of "those people" who flooded the market, and i got just what i deserved. :\

i think the biggest issue with costs is that at the present time, there is no set of metrics available that incentivizes (?) health insurance companies and biotech/pharma companies into having quality of life and length of life of patients be their top priority. We all want to be healthy and happy for as long as possible, but doing that doesn't make companies in the health care industry the most money. I see this every day at my job, unfortunately.

in theory if people would act in such a way to help reduce costs (AKA everyone works out, doesn't smoke, is proactive about seeing doctors early) then you are correct. But this is america, we are more focused on eating junk food, smoking a few packs a day, and watching reruns of american idol on our asses lol. people are so under motivated in this country ( that means a lot when a lazy 23 year old thinks so many people are lazy as shit)

i want to ride the "dumb people are dumb" train so badly, but i think it's missing the point.

with government intervention, costs go down (it doesn't in every case) because there's no profit margin, not because people are smarter or healthier or get more preventive care.

and when you turn doctors into social workers, now the best people don't go into that field anymore (although there will be some exceptions). there's always a cost when government comes in to save the day. there is no free lunch.

[edit: but the costs may turn out differently in the US unless there's a "no profit" clause somewhere in Obamacare. i'm just learning as i go here ppl... ]

i think the biggest issue with costs is that at the present time, there is no set of metrics available that incentivizes (?) health insurance companies and biotech/pharma companies into having quality of life and length of life of patients be their top priority. We all want to be healthy and happy for as long as possible, but doing that doesn't make companies in the health care industry the most money. I see this every day at my job, unfortunately.

but there's already a huge exercise and diet industry.

and we already know what happened when power hungry doctors and politicians tried to tell people how they should eat in the 70's... *cough* obesity epidemic *cough*.

but there's already a huge exercise and diet industry.

and we already know what happened when power hungry doctors and politicians tried to tell people how they should eat in the 70's... *cough* obesity epidemic *cough*.

Yeah I'm talking about prescription drugs, drug research, insurance formularies, etc, not diet and exercise. When Pfizer is thinking about what companies they want to purchase for drug development, they're not thinking about what conditions you might have that there's an unmet need for. They're looking for exclusivity, wide appeal, an assortment of treatment conditions, and increasingly an inability to be replicated (ie a biologic and not a pill that can be genericized). When health insurance companies decide what your copay is and how restricted drugs should be in each class (I understand you're unaware of this because you don't have health insurance ), they're not thinking about giving you all the available options or making sure you get the best treatment, they're looking to brutally reduce costs and constantly force generic usage.

i doubt anybody would call you poor or "one of those people" if they knew about the work you put in.

There you have it. Everyone poor is lazy ass 'those people' unless and until they prove otherwise. They are all sitting around too lazy to pick up the thousands of dollars lying at their feet.
Come on, man.

n0whereman wrote:

i think the biggest issue with costs is that at the present time, there is no set of metrics available that incentivizes (?) health insurance companies and biotech/pharma companies into having quality of life and length of life of patients be their top priority. We all want to be healthy and happy for as long as possible, but doing that doesn't make companies in the health care industry the most money. I see this every day at my job, unfortunately.

Somehow the health industry became about what lucrative procedures can be done and what insurers can avoid paying.
I don't necessarily agree that length of life should be a top priority. After a certain age, I think incredibly expensive surgeries or treatments that only provide a few extra months or years is something that may not be worth it.

I think a big problem with costs is that doctors are paid by the procedure, referral, visit, whatever. They are going to do what is profitable for them, as the back surgery example I posted earlier. They are going to give you non-generics if patients ask about medicines like our tv ads urge. Doctors get stuff from pharm reps to do just that. And most people do what their doctor says, because he's the doctor and who are you to know better than him, and people trust him. It's no wonder we have lots of misdiagnosis and ineffective or useless treatments.

People have no idea what a specific procedure or test costs. No one knows. Medical billers don't know. So there's plenty of potential for overcharging. I went to the doctor and was sent to get an x-ray. I called my insurance company to find out how much I'd pay. They said just my $25 copay. I go, they charge me $28, saying my insurance doesn't cover it, and my bill has $78 on it with some deferred something or other to make it $28. WTF is going on?
And insurance companies just look to avoid paying. For whatever they can get away with not paying. I for the life of me can't figure out why they don't support oversight of the people who are the ones costing them the money (the doctors and other suppliers of health care).
And then insurance companies don't tell you what costs what beyond some major categories.
Why are we kept in the dark? We should know if the doctor owns a piece of a testing center, what our insurance covers without having to call and ask them everything, and we should have our own medical records available. Then maybe we can begin to hold down costs by having the info necessary to make good decisions about our health.

Pharmaceutical companies only peddle shit until the generic comes out. For a while you couldn't escape a Gardisil commercial, now it's gone. What happened, did they wipe out HPV?
All they care about is market share, making stuff you have to take the rest of your life or patent-able biologically based medicines.


Some things are not made better by virtue of the pursuit of profit as the driving goal.

Create a public health insurance. If you don't have a job it is free. If you have a job it is paid by the employer.

Use the public hospitals to measure the costs of the different treatments. Treatments at private hospitals are then covered by the insurance if and only if they are in the same price range as equivalent treatments at the public hospitals.

Steppin Razor - a few things

- docs are required to disclose relationships with pharma companies now.
- you may not think an expensive procedure to gain a few months/years wouldn't be worth it now, but you might if you were about to become a parent/grandparent/a million other reasons. You could argue that there should be limits on these things in terms of insurance coverage, but gl drawing a line.
- Pharma companies do peddle shit after it goes generic - Pfizer, for example, has been making a HUGE push to keep people on lipitor despite it going generic in November. This is pretty irrelevant though - why would a drug company advertise a drug that they know docs won't prescribe? Docs know HPV exists, the ads are used to get YOU to suggest to your doc that you take it instead of another branded drug if you have HPV. How's that different from a Pepsi ad?

People have no idea what a specific procedure or test costs. No one knows. Medical billers don't know. So there's plenty of potential for overcharging. .

This is a massive part of the prob. I had zero info about cost pre surgery after talking to about 4 doctors- I literally was told by one it would be between 4K and 50K. People want to rip the free market but it really is a lack of any market whatsoever in medical care that drives cost up.

My surgical center fee was 8k- I showed up at 11:30Am and was out the door by 2:30. The actual surgery was 75 minutes the rest was paperwork/laying in recovery sobering up. You can't tell me a free market option can't simply provide a place for less than 8k. Regulations and govt. are what drive these insane costs and now we have decided to inject a massive dose of both into the U.S. system.

Two things I rarely hear people talk about in regards to medical insurance vs high costs:
1. umpteen million lawsuits -- if the doctor looks wrong at the patient. TORT Reform needed badly.

2. No, there is not a free market for health insurance. If there was, we would all be able able to shop around -- across state borders. Yes, Stupid Governments again. They think they are the smartest and overregulate everything. In the end, no one can enter the market except those with really really deep pockets. Open the state borders to purchase/sell insurance, and prices would drop.

Obamacare's final goal will be to push the private sector out, and control everything. This thread has already pointed out that the "penalty/tax" is much lower than the cost of being responsible.

Prices/Costs are going to skyrocket and the services will be crap (govt will be the monopoly).
Same thing happened with....
** The housing market. Govt made buying a house easy (and forced banks to give money to anyone). Prices rose, bubbled, and collapsed.
** Same with College. Student Loans galore (for basket weaving careers). Govt has recently made itself the sole student loan Santa Clause. How convenient. Watch the prices rise.....as the govt tries to monopolize its control.....

Yeah, for all of the good we want to do for society.....Govt is not the answer.....it is the problem.
To the subject heading......People will always game the system. That is one thing that I am strongly against.

People have no idea what a specific procedure or test costs. No one knows. Medical billers don't know. So there's plenty of potential for overcharging. I went to the doctor and was sent to get an x-ray. I called my insurance company to find out how much I'd pay. They said just my $25 copay. I go, they charge me $28, saying my insurance doesn't cover it, and my bill has $78 on it with some deferred something or other to make it $28. WTF is going on?
And insurance companies just look to avoid paying. For whatever they can get away with not paying. I for the life of me can't figure out why they don't support oversight of the people who are the ones costing them the money (the doctors and other suppliers of health care).
...

Some things are not made better by virtue of the pursuit of profit as the driving goal.

Two things I rarely hear people talk about in regards to medical insurance vs high costs:
1. umpteen million lawsuits -- if the doctor looks wrong at the patient. TORT Reform needed badly.

this might answer the first criticism to an extent. doctors feel compelled to run a dozen expensive tests because the cost of being wrong is so high. but i have to concede i see your point, Steppin, in why the insurance companies don't fight harder to drive down provider costs.

but back to profits, at least there's some push and pull between the insurance company and the provider. in trying to find a better way, we have to look at the alternative, and that is a government bureaucrat with a blank checkbook.

when only one side has a profit motive, we'll start seeing things like the government buying 5 thousand dollar toilet seats. there's phenomenal waste when people spend other people's money, and profits go up, not down, for those select few with government-approved monopolies to take advantage of it (think defense contracts). but at least there is (or was) some kind of equilibrium in the private health care industry when both parties look out for their best interests.

Yeah I'm talking about prescription drugs, drug research, insurance formularies, etc, not diet and exercise. When Pfizer is thinking about what companies they want to purchase for drug development, they're not thinking about what conditions you might have that there's an unmet need for. They're looking for exclusivity, wide appeal, an assortment of treatment conditions, and increasingly an inability to be replicated (ie a biologic and not a pill that can be genericized). When health insurance companies decide what your copay is and how restricted drugs should be in each class (I understand you're unaware of this because you don't have health insurance ), they're not thinking about giving you all the available options or making sure you get the best treatment, they're looking to brutally reduce costs and constantly force generic usage.

i see what you're talking about now. and maybe the answer is that the pharmaceutical and medical industry really is not in the health industry at all.

to the same extent that a car mechanic has no interest in pushing for more reliable cars in the marketplace, i don't see how doctors or pharmacists could want a healthier society. it's really not rational from their viewpoint.

it all seems like a scam. you go into a hospital, procedures pushed on you under stress, some innacurate prices might be thrown around, and then the bill shock. what other industry works like this? as per the previous analogy, car repair shops, obviously. and i'd say it's also partly the consumer's fault for giving doctors too much credit and putting them on pedestals.

in Milton Friedman's Free to Choose (episode 8, Who Protects the Worker, transcript], Friedman criticizes the monopoly of the medical field. paramedics are just as good as saving lives, and for much cheaper too. also, medics and corpsman saves lots of lives in war, and yet they don't have expensive medical degrees either. when i was in the military, i think i saw a doctor 1 time in 4 years (and for a simple physical before boot camp), and i wasn't worse off for it imo.

Today I got hit with yet another health care surprise. I don't want to derail the thread or get into a long diatribe on all the reasons this whole current system is fucked, BUT I will give you a cliffs version. System sucks. It's geared for two types, uber wealthy & the indigent. When I say "system" I don't just mean healthcare, but healthcare is easily the biggest issue we face. If you're not poor, the system is set up to make you poor (poor is defined by lack of disposable income and lack of ability to form capital).

I'll give you the primary example. I have a sister in law that had a kid 2 years ago. Cost to her? $0. Medicaid paid for it; her husband, my brother in law is an attorney in LA and makes 6 figures, but they postponed marriage until after the birth. Her income was all cash under the table from her nanny jobs.
My cousin has had 3 kids. Cost to her? $0. Medicaid and the State of California paid for them. I'm confident the subsequent health care has also been covered.

Me? Just had my first kid. We're on the lower end of the median income-wise. We have insurance and pay extra on top of the employer contribution in an attempt to get the child birth costs lower.
Cost to us? Right now around $8,000 with a nice annual renewal of $5,000 (and the 5k is if we don't go to the Dr. in the future), mind you these are POST tax dollars not pre-tax dollars.

Shit... I'm getting to the point where I'm going to be forced to grind up to midstakes just to try and rub some coin and better the family situation a bit... but oh, USA made playing poker so much more difficult. UGH. I don't want to confess what I'd do to this system if I were in charge

I do like Oliver's idea of a hybrid set-up, but I'd probably run it on the state level and banish the inane raping legislations that have been in place for the last three decades to set up these massive price distortions.

EDIT: wife just told me that "costs not covered by plan" is over $25,000 as of right now. Fuck em. This system is no system at all, and the solution was to make it worse... makes me want to puke. Sorry for the derail.

Two things I rarely hear people talk about in regards to medical insurance vs high costs:
1. umpteen million lawsuits -- if the doctor looks wrong at the patient. TORT Reform needed badly.

2. No, there is not a free market for health insurance. If there was, we would all be able able to shop around -- across state borders. Yes, Stupid Governments again. They think they are the smartest and overregulate everything. In the end, no one can enter the market except those with really really deep pockets. Open the state borders to purchase/sell insurance, and prices would drop.

Obamacare's final goal will be to push the private sector out, and control everything. This thread has already pointed out that the "penalty/tax" is much lower than the cost of being responsible.

Prices/Costs are going to skyrocket and the services will be crap (govt will be the monopoly).
Same thing happened with....
** The housing market. Govt made buying a house easy (and forced banks to give money to anyone). Prices rose, bubbled, and collapsed.
** Same with College. Student Loans galore (for basket weaving careers). Govt has recently made itself the sole student loan Santa Clause. How convenient. Watch the prices rise.....as the govt tries to monopolize its control.....

Yeah, for all of the good we want to do for society.....Govt is not the answer.....it is the problem.
To the subject heading......People will always game the system. That is one thing that I am strongly against.

1. You mean repeal of tort reform right?
When there's a hack MD they SHOULD be penalized for making mistakes. Tort reform itself is a bogus term invented by lobyists. To quote a senior judge here "there's no such thing as a frivolous lawsuit".

2. I agree 100%.

N0where:
Pharma companies know they're selling 100% useless products. Statin drugs (that lower cholesterol) don't prolong life, or even do anything beneficial. The disclaimer right on every commercial reads "does not prevent heart attacks". Statin drugs are the MOST prescribed drug in the world.

Research shows:
1. There's no casual relationship between cholesterol and heart disease.
2. Statins provide NO NONE, not 1 iota of benefit at all to women, or anybody over 50. In fact in people over 50, and women, higher cholesterol leads to LONGER life.

I think tort reform is a bit over-stated; but, I've been told by one of my friends that studied medicine abroad (and is a HUGE liberal) that in those other countries, healthcare is cheaper because "they don't have to worry about getting sued". I was a bit surprised by her comment. Generally, I'd view tort reform as minor in comparison to prodigious costs shifts and other distortions.

it all seems like a scam. you go into a hospital, procedures pushed on you under stress, some innacurate prices might be thrown around, and then the bill shock. what other industry works like this? as per the previous analogy, car repair shops, obviously. and i'd say it's also partly the consumer's fault for giving doctors too much credit and putting them on pedestals.

In ANY other industry, what you describe would be completely illegal. In part of our bill, the hospital shows us the "rate" and then an adjusted rate because we have insurance. So two different prices depending on if you have insurance? WTF.It's worse than you state here - the patient doesn't know the price UNTIL AFTERWARDS. I know, I called months ago to ask how much it would cost to have a child... they all look at you sideways for asking. When you're at the Dr's office, there's never ever a mention to costs...

For price distortions to cease, the person PAYING for the care also needs to be the one DECIDING to purchase the care and needs to be the one planning on RECEIVING the care (IMO, and know that others disagree with me). Right now, it's three disparate entities with their own motives